Dobscha Steven K, Morasco Benjamin J, Kovas Anne E, Peters Dawn M, Hart Kyle, McFarland Bentson H
Center to Improve Veteran Involvement in Care, Portland Veterans Affairs Medical Center, Portland, Oregon, USA.
Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA.
Pain Med. 2015 May;16(5):855-65. doi: 10.1111/pme.12643. Epub 2014 Dec 28.
The Department of Veterans Affairs (VA) uses the 11-point pain numeric rating scale (NRS) to gather pain intensity information from veterans at outpatient appointments. Yet, little is known about how NRS scores may vary over time within individuals; NRS variability may have important ramifications for treatment planning. Our main objective was to describe variability in NRS scores within a 1-month timeframe, as obtained during routine outpatient care in older patients with chronic pain treated in VA hospitals. A secondary objective was to explore for patient characteristics associated with within-month NRS score variability.
Retrospective cohort study.
National sample of veterans 65 years or older seen in VA in 2010 who had multiple elevated NRS scores indicating chronic pain.
VA datasets were used to identify the sample and demographic and clinical variables including NRS scores. For the main analysis, we identified subjects with two or more NRS scores obtained in each of two or more months in a 12-month period; we examined ranges in NRS scores across the first two qualifying months.
Among 4,336 individuals in the main analysis cohort, the mean and median of the average NRS score range across the 2 months were 2.7 and 2.5, respectively. In multivariable models, main significant predictors of within-month NRS score variability were baseline pain intensity, overall medical comorbidity, and being divorced/separated.
The majority of patients in the sample had clinically meaningful variation in pain scores within a given month. This finding highlights the need for clinicians and their patients to consider multiple NRS scores when making chronic pain treatment decisions.
美国退伍军人事务部（VA）使用11点疼痛数字评定量表（NRS）在门诊预约时收集退伍军人的疼痛强度信息。然而，对于NRS评分在个体内部如何随时间变化知之甚少；NRS的变异性可能对治疗计划产生重要影响。我们的主要目标是描述在VA医院接受治疗的老年慢性疼痛患者常规门诊护理期间，1个月时间范围内NRS评分的变异性。次要目标是探索与月内NRS评分变异性相关的患者特征。
回顾性队列研究。
2010年在VA就诊的65岁及以上退伍军人的全国样本，这些人有多个升高的NRS评分表明存在慢性疼痛。
使用VA数据集确定样本以及包括NRS评分在内的人口统计学和临床变量。对于主要分析，我们确定了在12个月期间的两个或更多个月中每个月都获得两个或更多NRS评分的受试者；我们检查了前两个符合条件月份的NRS评分范围。
在主要分析队列的4336名个体中，两个月内平均NRS评分范围的均值和中位数分别为2.7和2.5。在多变量模型中，月内NRS评分变异性的主要显著预测因素是基线疼痛强度、总体医疗合并症以及离婚/分居状态。
样本中的大多数患者在给定月份内疼痛评分存在具有临床意义的变化。这一发现凸显了临床医生及其患者在做出慢性疼痛治疗决策时考虑多个NRS评分的必要性。
